Approximately 44 million Americans need substance use treatment annually, according to the National Institute on Drug Abuse. However, only 1.5 percent (4.1 million) received substance use treatment, and an even smaller percentage received treatment at a residential addiction treatment (1.3 million) or outpatient facility (1.8 million). With such a large treatment gap, this highlights the importance of increasing access to treatment and providing educational resources about what to expect in professional inpatient drug rehab facilities and how to make the decision about choosing the right rehab.

What is Inpatient Drug Rehab?

Inpatient drug rehab (also called residential addiction treatment) is a type of specialist rehabilitative treatment for people with substance use disorders to assist them to stop using drugs and maintain their recovery. Think of it as staying at a special facility with around-the-clock care and supervision. There is a little more to it than that as each facility offers different levels of care depending on:

• The intensity of care required
• Severity of substance use disorder
• Whether detox is required
• Medical needs
• Co-occurring conditions
• How you are intending to pay for treatment
• Preferences of the client, like autonomy (keeping cell phones and computers), executive treatment, and amenities

It might be helpful to think of treatment as medical care, the more severe the condition, the more specialist treatment you’ll need.

In terms of the standards of medical and behavioral health needs, the American Society of Addiction Medicine (ASAM) has produced a set of guidelines (known as the ASAM Criteria) for the treatment of people with substance use disorder and co-occurring conditions, which we’ll describe below.

ASAM Criteria Continuum for Inpatient Rehab

The five levels of care for people with substance use disorders include

• Level 4 Medical Detox: medically managed inpatient treatment at either a specialist facility or hospital
• Level 3 Residential: usually at a standalone facility, providing different levels of care
  • 3.1 Clinically managed low intensity residential: this might be good for someone with low support needs and with less severe substance use disorder.
  • 3.5 Clinically managed high-intensity residential: this level is for people with more acute substance use disorder, potentially other co-occurring mental health conditions, and someone who needs 24-hour nursing support.
  • 3.7 Medically managed residential: as the name suggests, this type of facility has medical staff on site.
• Level 2 IOP/PHP: these are intensive outpatient facilities ranging in intensity and medical care. The programming might be similar to a residential treatment program, but patients return home at the end of the treatment session.
• Level 1 Outpatient: less intensive outpatient and medically managed outpatient. treatment, usually in a doctor’s office or community clinic.
• Recovery Residence: this is a sober living home, typically for people who have completed an inpatient rehabilitation program.

How Long is Inpatient Rehab?

The duration of inpatient drug rehab depends, much like the levels of care, on the individual’s needs, whether detox is required, co-occurring conditions, and design of the treatment center programs. As a rule of thumb, most residential addiction treatment programs are for a minimum of 30 days. Other programs may last for 90 days or even 12 months — these programs are considered long-term residential treatment.

The National Institute on Drug Abuse (NIDA) advises in their principles of effective treatment that remaining in treatment for an adequate period of time is critical. While duration is client need dependent, research indicates that most people with substance use disorders meet at least three months in treatment to see the best outcomes.

How Does Inpatient Rehab Work?

There are several principles to effective treatment. Depending on the type of drug use and needs of the client, an inpatient rehab program may be appropriate, and involves the following key elements:

• Intake and admission: during this period, clients complete paperwork, and turn over their belongings (some rehabs may inspect baggage to ensure that no prohibited items have been packed). Once this process is complete, you’ll be shown to your room or designated area in the facility.
• Assessment: at this stage, you should expect a comprehensive assessment that involves taking a detailed history of your substance use (drug of choice, dose, frequency, duration, etc.); medical history including any co-occurring conditions and medical needs; history of any previous attempts to stop using and symptoms experienced, overall health and symptoms upon admission.
• Detox: depending on the severity of substance use disorder, substance used, and medical needs, you may first enter a detox phase of treatment. This may involve the use of medication to relieve withdrawal symptoms and make the process as comfortable as possible. For individuals with a history of opioid use, research shows that medication-assisted treatment should be the first line of treatment, followed by behavioral therapy. NIDA advises that detox alone is not sufficient to complete treatment; you’ll need to then enter the rehabilitation part of addiction treatment.’
• Rehab: this part of the program involves individual and group therapy, behavioral counseling, skills training, educational groups, and other types of supportive therapy. These may include cognitive behavioral therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), dialectical behavioral therapy (DBT), motivational interviewing, twelve-step facilitation, family therapy, animal-assisted therapy, and other complementary therapies like acupuncture, meditation, and yoga. Think of this stage as enhancing your coping mechanisms, teaching you new skills, and providing you with key knowledge about substance use disorders to prevent returning to use (also called relapse).
• Aftercare/continuing care: typically, you’ll work on an aftercare plan with your therapist/counselor before leaving treatment. Some rehabs have alumni programs and others may require follow up visits and ongoing recovery support meetings. Think of this part as maintaining the critical skills you’ve learned in rehab to maintain your sobriety.

Bottom line: rehab should treat the whole person to be successful, addressing medical, mental, social, occupational, family, and legal needs to help you, or your loved one, succeed in your recovery.

How Much Does Inpatient Rehab Cost?

The cost of residential addiction treatment varies depending on:

• Insurance coverage
• Amenities
• Duration of treatment
• If detox is required
• Location of the facility

Does Insurance Cover Inpatient Rehab?

It depends. Most insurers cover a portion of the cost of addiction treatment. For example, some cover inpatient and outpatient programs, and some do not cover detox. It’s best to call your insurer to find out your level of coverage and out-of-network benefits.

It is possible to get insured under Medicare and Medicaid, but there are certain stipulations.

Medicare covers people over the age of 65 or those who experience disabilities. Whereas Medicaid covers people:

• Over the age of 65 or under 19-years old
• Parents or pregnant people
• Low income individuals and families

Are There Free Inpatient Rehabs?

Most rehabs take insurance or private pay (out of pocket) payments. Some will take Medicare, military insurance, and Medicaid, too. A smaller portion of treatment facilities offer scholarships or sliding scale payment options too for low income individuals and people without insurance. It is typically state funded and nonprofit rehabs that offer free to low cost treatment options and are most accessible to people with limited funds and coverage.

Pros & Cons of Inpatient Rehab

Pros:

• Receive treatment from addiction specialists
• Can aid the detox process and minimize withdrawal symptoms
• You’ll have medical care in case of complications
• Learn new skills
• Takes you away from the stressors of your home environment, work, and other stressful situations
• Build a recovery community
• Can help provide stabilization for co-occurring conditions
• You won’t have temptations around you
• Feel supported by others going through the same process

Cons:

• Inpatient care is more expensive than outpatient
• Your insurance may not cover the full cost
• You still have to return home after treatment
• You may not be allowed to use your phone or computer
• You will have to take time off work
• You may have to travel for treatment

When to Consider Inpatient vs. Outpatient Rehab

When deciding whether to choose an inpatient or outpatient facility it’s important to understand the client’s individual needs, specifically:

• A need for detox and potential withdrawal symptoms
• Existing medical conditions and potential complications
• Co-occurring mental health conditions
• Readiness to change
• Risk of relapse or continued use
• Whether there is a supportive living environment at home and social supports

If the person has any risk of detox symptoms or complications, and co-occurring conditions it may be necessary to choose an inpatient rehab. You should speak to a medical and addiction treatment professional who can advise you about the appropriate placement and level of care.

What to Look For in Inpatient Rehab Facility

There are several factors to consider when looking for an inpatient rehab facility. Think of these as essential considerations and like-to-have deciding factors:

Essential Considerations

• Expertise: Can the facility treat your level of substance use disorder? It’s important to know if they are qualified and have the technical skills and expertise to support you, or your loved one
• Detox:
  • Do they have detox options? Are they medically supervised?
  • What medications do they use for detoxification? Are they FDA approved? How many clients have they successfully detoxed from the substance you use?
• Medical emergencies: You’ll want to check how they safeguard patients. What expertise do they have to treat complications? Medical emergencies can occur, especially during some detox situations. You’ll want to know their protocols, the medical staff at the facility, and how close they are to a hospital.
• Trauma-informed care: You’ll want to check that the facility is trauma-informed. Given that 75 percent with substance use disorder have experienced trauma, this is an important component of care.
• Co-occurring expertise: Can they treat co-occurring conditions? This is crucial when treating substance use disorders because you’ll want to ensure both conditions are managed effectively. You may also want to ask how many patients they have successfully treated with your specific co-occurring condition.
• Staff to patient ratio: Ask the facility what their staff to patient ratio is as this will tell you how much support you’ll have, and how long you may have to wait to receive a response.
• Employment status: Do they employ their support staff or are they contractors or on-call providers? This will indicate continuity of care and in some instances, you may find that there isn’t an effective handover between shifts if they are short staffed. This is where accidents and mistakes may happen.
• Availability of medical doctor: Ask the facility how frequently the doctor checks in on you. A doctor visiting once a week may be less responsive to medication changes and responding to treatment needs.
• Length of treatment: ensure that they have a program duration long enough to support effective treatment of your condition, severity of substance use, and care needed for your other medical conditions. Conversely, you may also want to ensure the program isn’t unnecessarily long. If it is longer than three months, ask them for their research to justify the program length and evidence of treatment outcomes.

Nice-to-Have Deciding Factors

• Amenities: while some of these may be essential, like ADA accessible rooms, other options, like luxury amenities depend on the facility. For example, executives might want a business center with cell, WIFI, and computer access, so they will need a facility that doesn’t restrict that access. Others might want a pool or private room.
• Proximity: some individuals like to travel out-of-state for treatment, whereas others may want to be close to home. Note: traveling to a different state may impact your out-of-network benefits, so you’ll want to consider that and check with your insurance provider.

Sources

1. National Institute on Drug Abuse. Addiction Treatment. https://nida.nih.gov/nidamed-medical-health-professionals/treatment/addiction-treatment
2. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States. Results from the 2021 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHFFRRev010323.pdf
3. American Society of Addiction Medicine. (2024). About the ASAM Criteria. https://www.asam.org/asam-criteria/about-the-asam-criteria
4. National Institute of Drug Abuse. (2014). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). https://archives.nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf
5. National Institute of Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction. Treatment and Recovery. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery